Movement Disorders Associated With Antipsychotic Medication in People With Schizophrenia: An Overview of Cochrane Reviews and Meta-Analysis

Abstract

Movement disorders associated with antipsychotic medications are relatively common, stigmatising, and potentially disabling. Their prevalence in people with psychosis who are prescribed second-generation antipsychotics (SGAs) is uncertain, as is their level of recognition by clinicinas. We conducted meta-analyses of randomised controlled trials included in the Cochrane Database of Systematic Reviews on schizophrenia and schizophrenia-like psychoses to estimate the prevalence of new-onset dystonia, akathisia, parkinsonism, and tremor with SGAs (amisulpride, asenapine, aripiprazole, clozapine, olanzapine, paliperidone, quetiapine, risperidone, L-sulpiride, and ziprasidone) approved in Canada and the UK, comparing them with haloperidol and chlorpromazine. We used a random effects model because of the heterogeneity between-studies in drug dosage and method of ascertainment of movement disorders. Our systematic search yielded 37 Cochrane systematic reviews (28 for SGAs), which generated 316 informative randomised controlled trials (243 for SGAs). With respect to SGAs, prevalence estimates ranged from 1.4% (quetiapine) to 15.3% (L-sulpiride) for dystonia, 3.3% (paliperidone) to 16.4% (L-sulpiride) for akathisia, 2.4% (asenapine) to 29.3% (L-sulpiride) for parkinsonism, and 0.2% (clozapine) to 28.2% (L-sulpiride) for tremor. Prevalence estimates were not influenced by treatment duration, the use of a flexible or fixed dosing scheme, or whether studies used validated instruments for the screening/rating of movement disorders. Overall, we found high overlap on the prevalence of new-onset movement disorders across different SGAs precribed for established psychoses. Variations in prevalence figures across antipsychotic medications were observed for the different movement disorders. Differences in pharmacological properties, such as for the dopamine D R association rate and serotonin 5-HT antagonism, could contribute to this variation.

A review and guide to drug‐associated oral adverse effects—Dental, salivary and neurosensory reactions. Part 1

“…They usually present as lip‐smacking, grimacing, puckering, rapid eye blinking and dyskinetic tongue movements, such as protrusion and tongue rolling . TDK can be stigmatising for patients, and adversely affect medication adherence and quality of life, sometimes persisting even after the medication is stopped . It is believed that the pathophysiology of TDK arise from drugs that block central dopamine receptors, although other neurotransmitters may be involved …”

“…TDK can be stigmatising for patients, and adversely affect medication adherence and quality of life, sometimes persisting even after the medication is stopped . It is believed that the pathophysiology of TDK arise from drugs that block central dopamine receptors, although other neurotransmitters may be involved …”

Parkinsonism in the psychiatric setting: an update on clinical differentiation and management

“…Although DIP is less frequent with atypical antipsychotics than typical agents such as haloperidol,17 it is still commonly seen. A recent Cochrane review concluded that DIP has been associated with all second-generation antipsychotics 18…”

Antipsychotic Drug-Induced Movement Disorders: A Forgotten Problem?

“…Women were more commonly treated with quetiapine than men (15.8 vs 10.9 per 1000), and the top 4 diagnostic codes associated with quetiapine use were depression, neurotic disorders, bipolar disorder, and sleep disturbances. 12 In the study by Martino and colleagues, 13 we seek to focus attention back on the issue of antipsychotic-induced movement disorders (extrapyramidal symptoms). We hope to highlight that while the prevalence of such movement disorders appears to be lower with the newer antipsychotic medications than with the first-generation agents, the 95% confidence intervals often overlap between new and older agents, and the risk remains substantial.…”

“…We hope to highlight that while the prevalence of such movement disorders appears to be lower with the newer antipsychotic medications than with the first-generation agents, the 95% confidence intervals often overlap between new and older agents, and the risk remains substantial. 13 Now that antipsychotic medication is used and prescribed by a great number of practitioners to a diverse population of patients, the need for vigilant monitoring has intensified. Many practitioners who began their training in the era of second-generation antipsychotics have not received the same degree of exposure to the recognition and management of antipsychoticinduced movement disorders.…”